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Technology Service Request Form
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Department / Program
*
Your answer
Phone Number
*
Your answer
Supervisor/Director/Principal
*
Your answer
Technology Requested:
Please provide a brief description of the needed technology.
*
Your answer
Purpose
Please provide a short description of how this technology will be used.
*
Your answer
Date of Request
*
MM
/
DD
/
YYYY
Date Technology is Needed
*
MM
/
DD
/
YYYY
Time of the Event
*
Time
:
AM
PM
Location Of the Meeting/Training
*
IEA
School Site
PSRC Blue Room
PSRC Boardroom
PSRC Curriculum Room
PSRC Transportation Classroom
School Site Location information
Where ( Building, Room Number)
Your answer
How many people in the training/workshop
*
Your answer
Do you need additional Chromebooks for training?
*
Yes
No
Will you need Guest Mode on the Chromebooks?
*
Yes
No
Training provided by:
*
PSRC Employee
Outside Vendor
Please provide contact information for the PSRC Employee / Outside Vendor (phone number & email address)
*
Your answer
Audio Equipment needed
*
Microphones
Interactive Board
Will there be any sites/video links being used during the presentation? - URLs must be provided ahead of time to ensure that they will play on our network.
*
Yes
No
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